[Changes in cardiovascular risk factors in developing countries]

As a result of progressive urbanization and westernization of their lifestyle, developing countries are now undergoing an epidemiological transition. These changes are leading to a new epidemiological situation in the world with a decline in infectious diseases and emergence of cardiovascular diseases in general and coronary artery disease in particular. From the current level of 16 millions deaths annually worldwide, mortality due to coronary heart disease is expected to double in the next 20 years with 80% of this increase occurring in developing countries. INTERHEART was a large international study designed to assess the importance of cardiovascular risk factors (CVRF) in terms of prevalence and coronary-related morbidity worldwide. The main modifiable CVRF, i.e., tobacco use, hypertension, diabetes, obesity, blood apolipoproteins, and psychosocial factors were strongly correlated with the risk for myocardial infarction (MI). The level of risk associated with these CVRF was the same in industrialized and developing countries. Globally tobacco use remains the most serious epidemiological risk in terms of prevalence of coronary artery disease whereas raised lipid level was the factor most strongly correlated with MI risk in terms of coronary morbidity particularly in Africa. The greatest impact of the strong increase in diabetes and hypertension with accompanying obesity was observed in countries in Southeast Asia and Africa. The emergence and rapid growth of CVRF in developing countries accounts for the strong increase in coronary-related morbidity/mortality predicted over the next two decades and further underlines the need for an epidemiological control plan aimed at preventing cardiovascular disease in developing countries..